Palliative Radiotherapy for Painful Bone Metastases from Solid Tumors Delivered with Static Ports of Tomotherapy (TomoDirect): Feasibility and Clinical Results. (21st October 2014)

• Record Type: Journal Article
• Authors: Franco, Pierfrancesco; Migliaccio, Fernanda; Angelini, Veronica; Cante, Domenico; Sciacero, Piera; Peruzzo Cornetto, Andrea; Casanova Borca, Valeria; Zeverino, Michele; Torielli, Paolo; Arrichiello, Cecilia; Girelli, Giuseppe; La Porta, Maria Rosa; Tofani, Santi; Numico, Gianmauro; Ricardi, Umberto
• Is Part Of: Cancer investigation. Volume 32:Number 9(2014)
• Page Start: 458
• Page End: 463
• Publication Date: 2014-10-21
• Subjects: Cancer -- Periodicals; Oncology -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- Periodicals; 616.994
• DOI: 10.3109/07357907.2014.958495
• Languages: English
• ISSNs: 0735-7907

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <p> <italic>Purpose</italic>: To evaluate the feasibility and response to palliative radiotherapy delivered with static ports of tomotherapy—TomoDirect (TD) in patients affected with painful bone metastases from solid tumors. <italic>Methods</italic>: A prospective cohort of 130 patients (185 osseous lesions) was treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy × 10; 4 Gy × 5; 8 Gy × 1). Pain response was investigated at 2 weeks and 2 months (for evaluable patients). The Numeric Rating Scale (NRS-11) was used to assess pain. Response rates to radiotherapy were calculated following the criteria of the International Bone Metastases Consensus Group (IBMCG), accounting for the use of concomitant analgesics (response: complete or partial; non-response: stable pain, pain progression or "other"). Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED). <italic>Results</italic>: Most of the patients had 1–2 bone metastases (91); those with multiple lesions mostly had a metachronous presentation (60%). Synchronous lesions were mainly approached with multiple plans (63%). Most treatments employed 3–4 fields (77%). Treatment times ranged from 255 to 939 s depending on fractionation, fields, and target lesions number. At 2 weeks, the median self-reported worst pain decreased significantly as median oral morphine-equivalent dose regardless of fractionation used. The response rate according to the IBMCG-based response categories ranged from 45 to 55%. Pain relief duration seems (response at 2 months) slightly inferior with the single fraction approach, with a higher re-treatment rate. At 2 weeks, the median self-reported worst pain and OMED significantly decreased regardless of fractionation (response rate: 49–55%). Pain relief decreased at 2 months, especially for single fraction (higher re-treatment rate). <italic>Conclusion</italic>: TD is a valid option to deliver palliative radiotherapy for painful bone metastases from solid tumors.</p> </abstract>